单中心回顾：术前发热联合NLR对复杂性 阑尾炎的预测价值

Single-Center Retrospective Study: Predictive Value of Preoperative Fever Combined with Neutrophil-to-Lymphocyte Ratio (NLR) for Complicated Appendicitis

摘要: 目的：探讨术前发热及中性粒细胞/淋巴细胞比值(NLR)对复杂性阑尾炎的预测价值。方法：回顾性收集2021年1月至2024年12月北华大学附属医院普外科收治的急性阑尾炎患者215例，根据术后病理结果将患者分为复杂性阑尾炎(Complicated Appendicitis)组(坏疽性、穿孔性，n = 76)与非复杂性阑尾炎(Uncomplicated Appendicitis)组(单纯性、化脓性，n = 139)。比较两组临床资料及术前NLR水平，采用Logistic回归分析复杂性阑尾炎的独立危险因素，绘制ROC曲线评估NLR预测复杂性阑尾炎的效能。结果：复杂性阑尾炎组NLR中位数为11.95 (9.39~16.38)，显著高于非复杂性阑尾炎组3.55 (2.27~5.88) (P < 0.001)。单因素Logistic回归显示NLR (OR = 1.91, 95% CI: 1.60~2.28, P < 0.001)。多因素Logistic回归显示发热(OR = 12.10, 95% CI: 3.84~38.06, P < 0.001)和NLR (OR = 1.56, 95% CI: 1.28~1.89, P < 0.001)均为独立危险因素，其中发热为强预测因子。ROC曲线分析显示NLR预测复杂性阑尾炎的AUC为0.949 (95% CI: 0.916~0.981)，最佳截断值为7.74，敏感度88.2%，特异度91.4%。结论：术前发热联合NLR对复杂性阑尾炎具有良好的预测价值，发热作为临床直观指标OR值最高，NLR ≥ 7.74可作为临床术前筛查指标。

Abstract: Objective: To investigate the predictive value of the preoperative fever combined with neutrophil-to-lymphocyte ratio (NLR) for complicated appendicitis. Methods: A total of 215 patients with acute appendicitis admitted to the Department of General Surgery, the Affiliated Hospital of Beihua University from January 2021 to December 2024 were retrospectively enrolled. According to postoperative pathological results, patients were divided into the complicated appendicitis group (gangrenous and perforated appendicitis, n = 76) and the uncomplicated appendicitis group (simple and suppurative appendicitis, n = 139). Clinical data and preoperative NLR levels were compared between the two groups. Logistic regression analysis was used to identify independent risk factors for complicated appendicitis, and receiver operating characteristic (ROC) curves were plotted to evaluate the predictive efficacy of NLR for complicated appendicitis. Results: The median NLR in the complicated appendicitis group was 11.95 (9.39~16.38), which was significantly higher than 3.55 (2.27~5.88) in the uncomplicated appendicitis group (P < 0.001). Univariate logistic regression showed that NLR was associated with complicated appendicitis (OR = 1.91, 95% CI: 1.60~2.28, P < 0.001). Multivariate logistic regression demonstrated that NLR (OR = 1.56, 95% CI: 1.28~1.89, P < 0.001) and fever (OR = 12.10, 95% CI: 3.84~38.06, P < 0.001) were independent risk factors. ROC curve analysis showed that the area under the curve (AUC) of NLR for predicting complicated appendicitis was 0.949 (95% CI: 0.916~0.981), with an optimal cutoff value of 7.74, a sensitivity of 88.2%, and a specificity of 91.4%. Conclusion: Preoperative fever combined with NLR showed good predictive value for complicated appendicitis. Fever, as a clinically intuitive indicator, demonstrated the highest odds ratio (OR = 12.10, 95% CI: 3.84~38.06), while an NLR ≥ 7.74 can serve as a clinical preoperative screening indicator.